by Tara Lee, RN, BSN
We need courageous leadership for meaningful change.
Cover-Up Culture creates a toxic environment where management consistently cares more about maintaining power than they do about the dignity and safety of their employees. Blame, shame, and humiliation are used to control staff. Secrecy and lack of transparency keep everyone on edge. Fear prevents staff from speaking up with concerns. Complacency takes the place of compassion. Mistrust and uncertainty run rampant. Burnout is inevitable.
Cover-up Culture in any organization is dangerous; in hospitals it can be deadly.
“When the culture of an organization mandates that it is more important to protect the reputation of a system and those in power than it is to protect the basic human dignity of individuals or communities, you can be certain that shame is systemic, money drives ethics, and accountability is dead.” — Brené Brown, Dare to Lead
I am an experienced psychiatric nurse. I was accused of insubordination and threatened with termination for voicing grave safety concerns at Hospital X. I chose to resign, but I won’t be silenced.
I am still recovering from the trauma of the humiliation. Part of me is begging me to let it go and allow it to be someone else’s problem. That’s how I would have reacted a few years ago — turning the other cheek and internalizing the shame. Fortunately, I’m no longer that person.
The new, compassionate Me will not be ruled by complacency. I’ve found my spine; I am fiercely compassionate — not only to protect myself, but to protect others as well. I will speak up against Cover-Up Culture.
I will be the person who I wish had been there for me when I was trapped in uncertainty, shame, and fear.
I was excited about my new job on the inpatient adolescent psychiatry unit at Hospital X. I was eager to use my skills and experience to help adolescents and young adults recover from and avoid the type of trauma that ruins lives. I had been a nurse on a similar unit in Washington State and found the work both challenging and rewarding. I was thrilled to learn that Hospital X was a teaching hospital for Harvard University. I trusted the staff to be trauma-informed and current on the latest treatments.
I had a very rude awakening.
The red flags were evident on my first day of orientation. Hospital X’s on-boarding of new employees is inadequate and unprofessional. I foolishly hoped things would get better once I started on my new unit. Unfortunately, things got much, much worse.
A therapeutic environment is non existent in adolescent psychiatry at Hospital X. There is no compassionate care. The patients run the show. Staff look on helplessly as patients constantly test the non-existent limits. There are no boundaries set nor modeled, no consequences, no consistency of care. Neither patients nor staff have any idea what is expected of them, nor what they can expect from each other.
The environment at Hospital X is a stark contrast to the unit I had worked on previously, where expectations and boundaries were clear, limits were enforced in a safe and compassionate manner, and there was respect and dignity for all.
It was hard to believe it could be so bad at Hospital X, a facility affiliated with the prestigious Harvard University School of Medicine. I started voicing concerns and looking for allies, but I realized I was very much alone.
Then I discovered the cause — Cover-Up Culture.
The management I interacted with at Hospitl X is manipulative and intimidating, causing ripples of trauma throughout the organization. The fear amongst patients and staff is palpable. Inappropriate behavior is allowed, and even encouraged, resulting in verbal altercations, assaults, property damage, and escapes. It was chaos — and for the patients coming from chaotic situations, it must have felt like home.
Hospital X is not helping these patients recover from trauma; they are contributing to it. The families remain ignorant of the dysfunction at the facility — HIPPA violations, dangerous medication administration practices, inappropriate use of restraints, insecure key distribution, presence of contraband, lack of adherence to crisis-prevention policies…
Most of the staff appear to have good intentions, but poor leadership prevents them from living up to the hospital’s own Mission Statement and Code of Conduct. Staff are afraid to speak up. There is high turnover and the inexperienced staff don’t seem to realize that things can, and should, be different.
I got a sense that Hospital X is well aware of their vulnerability. Much of the orientation consisted of meaningless checklists in order to shift the blame from facility to individuals. The employees are unaware of their powerlessness — the organization’s lawyers make sure of that.
Getting rid of someone who might expose weaknesses is so much easier than facing the truth of the dysfunction.
The psychiatrists and social workers should know better, but they too seemed powerless to stand up to management. Their complacency makes the professionals complicit to the abusive practices at the facility, and yet they don’t seem to realize that it’s their licenses on the line. When I spoke up for safety during rounds, the nurse manager silenced me as if I were a child. It was humiliating. Not one person stood up for me — not in the moment and not in the aftermath of my being disciplined. This speaks to a lack of courage amongst the professionals. I understand their fear, but I will no longer live controlled by it.
I lost my job for doing my job. I didn’t break their Code of Conduct, they did.
I was humiliated, intimidated, and retaliated against. The nurse manager lied to me — saying we would meet with a mediator, when in reality I was called to a closed-door disciplinary meeting which they refused to record.
I was demonized — accused of insubordination with no opportunity to defend myself. It was surreal — one of the most traumatizing experiences of my life — a team of psychiatric professionals accusing me of insubordination for voicing safety concerns. It made no sense.
After resigning I raised my concerns to the highest level of the organization. I had hoped the dysfunction was limited to that particular unit. Initially the CEO seemed receptive, but I soon realized that he too was just playing the game. Despite a long conversation with one of their lawyers — supposedly conducting an investigation into my concerns — nothing appears to have changed.
Cover-Up Culture is clearly entrenched at Hospital X.
Months later, I am still out of work and trying to make sense of things, while Hospital X just received a workplace wellness award. The hypocrisy is glaring.
Enough is enough.
Hospital X likely assumes they are done with me — that I will disappear and not rock their precarious boat ever again.
Friends and professionals have advised me to move on, to let it go — they’re worried that I will be further harmed by speaking up.
Some have warned me that Hospital X has the power to destroy my career, but staying silent to protect my career is cowardice. Silence allows them to continue their abusive ways. I have no choice but to speak up. If Hospital X attempts to ruin my career further, they will merely reinforce my narrative.
Call me naïve, but I’m putting my trust in the power of fierce compassion.
I can no longer compromise my values by staying silent.
I will continue to speak up for safety. I will live by Hospital X’s own values of Community, Integrity, Respect, Compassion, Learning, Excellence. I will seek out others who have suffered. I will be the voice for those who are unable to defend themselves.
I know I am not alone. This is a rallying cry. I hope others will find the courage to speak up with me. We need many voices to win the fight against Cover-Up Culture in healthcare.